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Table 2 Description of included studies

From: Health service brokerage to improve primary care access for populations experiencing vulnerability or disadvantage: a systematic review and realist synthesis

† = associated citations
Stated aims Study design Vulnerability experienced Outcomes assessed Program quality (rigour) and program description (relevance)
Braun 2015 [36] United States To present findings from an RCT of the use of navigators to reduce disparities that Asian and Pacific Islander Medicare recipients experience in accessing breast, cervical, prostate and colorectal cancer screening. Randomised controlled trial Asian and Pacific Islander Medicare beneficiaries with low screening participation on the medically underserved island of Moloka’i in Hawaii. Screening prevalence, satisfaction with navigation services Moderate (6) and thick (4)
Han 2009 [37]
United States
To evaluate the effect of a lay health worker (LHW) intervention to promote breast cancer screening among Korean-American women who are predominantly first-generation immigrants Pre−/post-test intervention (no control) Korean-American women in the United States (predominately first-generation immigrants) Changes in screening behaviours, changes in breast cancer knowledge and beliefs. Moderate (4) and thick (4)
Hiatt 2008 [38]
United States
To evaluate an outreach intervention using lay health worker peers and a clinic provider inreach intervention to improve breast and cervical cancer screening Quasi-experimental controlled community evaluation trial (pre- and post-test) Underserved low-income African American, Chinese, Hispanic, and White women, 40 to 75 years of age, in two counties in the United States Screening behaviour Moderate (5) and thin (2)
Mason 2013 [34]
United States
To present a process and outcome evaluation of a community patient navigation program to encourage mammography screening among underserved women. Program evaluation Underserved African American women in Georgia. Mammogram uptake Weak (3) and thick (4)
Dennis 2015 [17]
To explore the views of Aboriginal people on their experiences of a brokerage model for access to community-based mainstream health services in an urban setting in New South Wales. Mixed methods Aboriginal people in South West Sydney Improvement in access to health care, satisfaction with service Moderate (4) and thin (2)
Findley 2011 [32]
United States
To describe community-based care coordination programs for childhood asthma and operational statistics at five different sites Program evaluation Low income and ethnically diverse. Caregiver confidence, change in health service utilisation (ED visits and hospitalisation), school absences, asthma management. Moderate (5) and thick (4)
Johnson 2012 [39]
United States
To describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are high consumers of health resources in a Medicaid managed care system. Retrospective non-randomised cohort study High users of health services such as ED, people with high consumption of controlled substances, poorly controlled chronic diseases and people with high use of disease management referrals, family or provider referrals, and care coordination referrals. ED utilization and payment; inpatient utilization and payment; prescription counts and payment; narcotic counts and payment; PCP visits and payment; specialist (non-PCP visits and payment). Moderate (6) and thick (4)
Jordan 2013 [33] United States To provide a) an overview of the NYC experience with HIV-infected people entering jails, b) a review of the methods used to provide services that facilitate continuity of care from jail to community primary care, and c) an assessment of the program outcomes of the transitional care coordination program. Program evaluation People with HIV returning home from jail Releases to the community with a discharge plan, linkages to community primary care, linkages to primary care/releases to the community. Moderate (5) and thick (3)
Krantz 2013 [30]
United States
To evaluate whether a program to prevent coronary heart disease (CHD) with community health workers (CHWs) would improve CHD risk in public health and health care settings Program evaluation Residents in 34 primarily rural Colorado counties Change in Framingham Risk Score (Primary)
Changes in other health outcomes: Body mass index; Weight; Systolic BP; Diastolic BP; Total cholesterol; HDL cholesterol; LDL cholesterol (Secondary)
Moderate (4) and thick (4)
Wang 2012 [35] †b
United States
To compare two interventions designed to improve primary care engagement and reduce acute care utilization: Transitions Clinic, a primary care–based care management program with a community health worker, versus expedited primary care. Randomised controlled trial Individuals who were recently released from prison. Visits to the study-assigned primary care clinic, visits to the medical or psychiatric ED that did not result in a hospitalization, rate of ED use, hospitalization, having any incarceration, time to first incarceration. Moderate (6) and thick (4)
Whitley 2011 [31]
United States
To describe the findings of a program employing community health workers to provide free CVD screening and education Program evaluation Underserved populations- including the uninsured, racial and ethnic minorities, the homeless, migrant and resort workers and small business employees Referrals to primary care and/or other resources, follow-up contacts. Moderate (4) and thin (2)
  1. aHiatt, R.A., et al., Community-Based Cancer Screening for Underserved Women: Design and Baseline Findings from the Breast and Cervical Cancer Intervention Study. Preventive Medicine, 2001. 33(3): p. 190–203
  2. b Wang EA, Hong CS, Samuels L, Shavit S, Sanders R, Kushel M. Transitions clinic: creating a community-based model of health care for recently released California prisoners. Public health reports (Washington, DC: 1974). 2010;125:171–7